High-energy Tibial Plateau Fractures Research Articles

Application of reverse traction device in preoperative treatment of high-energy tibial plateau fracture

To investigate the effectiveness of the reverse traction device in the preoperative treatment of high-energy tibial plateau fractures. A retrospective study was conducted to analyze the clinical data of 33 patients with high-energy tibial plateau fractures who met the selection criteria between December 2020 and December 2023. All patients were treated by open reduction and internal fixation. According to the preoperative traction method, they were divided into the observation group (16 cases, treated with a reverse traction device on the day of admission) and the control group (17 cases, treated with heel traction on the day of admission). There was no significant difference in baseline data such as gender, age, body mass index, affected side, cause of injury, fracture Schatzker classification between the two groups ( P>0.05). Preoperative waiting time, preoperative related complications (nail channel loosening, nail channel oozing, nail channel infection, soft tissue necrosis, soft tissue infection, deep vein thrombosis of the lower extremity, etc.), operation time, and total hospitalization time were recorded and compared between the two groups. On the 4th day after traction, visual analogue scale (VAS) score was used to evaluate the pain relief of the patients, the swelling value of the affected limb was measured, and the Immobilization Comfort Questionnaire (ICQ) score was used to evaluate the perioperative hospital comfort of the patients. Both groups of patients completed the operation successfully, and the operation time, total hospitalization time, and preoperative waiting time of the observation group were significantly less than those of the control group ( P<0.05). There was no preoperative related complications in the observation group; in the control group, 3 patients had nail channel loosening and oozing, and 2 cases had the deep vein thrombosis of the lower extremity; the difference in the incidence of complication between the two groups was significant ( P<0.05). On the 4th day after traction, the ICQ score, VAS score, and limb swelling value of the observation group were significantly better than those of the control group ( P<0.05). X-ray films showed that the tibial plateau fracture separation and lower limb alignment recovered after calcaneal traction in the control group, but not as obvious as in the observation group. The fracture gap in the observation group significantly reduced, the tibial plateau alignment was good, and the lateral angulation deformity was corrected. The use of reverse traction treatment in patients with high-energy tibial plateau fractures on admission can accelerate the swelling around the soft tissues to subside, reduce patients' pain, shorten the preoperative waiting time, improve the patients' preoperative quality of life, and contribute to the shortening of the operation time, with a good effectiveness.

Early Versus Delayed Definitive Fixation Relative to Fasciotomy Closure in High-Energy Tibial Plateau Fractures With Compartment Syndrome.

To evaluate the timing of definitive fixation of tibial plateau fractures relative to fasciotomy closure with regard to alignment and articular reduction. Retrospective case series. Four Level I trauma centers. Patients with tibial plateau fractures (TPF) with ipsilateral compartment syndrome treated with fasciotomy between 2006 and 2018 met inclusion criteria. Open fractures, patients younger than 18 years, patients with missed or delayed treatment of compartment syndrome, patients with a diagnosis of compartment syndrome after surgical fixation, and patients whose plateau fracture was not treated with open reduction and internal fixation were excluded. Patients were divided into 2 groups depending on the relative timing of fixation to fasciotomy closure: early fixation (EF) was defined as fixation before or at the time of fasciotomy closure, and delayed fixation (DF) was defined as fixation after fasciotomy closure. Radiographic limb alignment (categorized as anatomic alignment (no varus/valgus), ≤5 degrees varus/valgus, or >5 degrees varus/valgus) and articular reduction (categorized as anatomic alignment with no residual gap or step-off, <2 mm, 2-5 mm, and >5 mm of articular surface step-off) were compared between early and delayed fixation groups. In addition, superficial and deep infection rates were compared between those in the EF and DF cohorts. Subgroup analysis within the EF cohort was performed to compare baseline characteristics and outcomes between those that received fixation before closure and those that underwent concurrent fixation and closure within one operative episode. A total of 131 patients met inclusion criteria for this study. Sixty-four patients (48.9%) were stratified into the delayed fixation group, and 67 patients (51.1%) were stratified into the early fixation group. In the EF cohort, 57 (85.1%) were male patients with an average age of 45.3 ± 13.6 years and an average body mass index of 31.0 ± 5.9. The DF cohort comprised primarily male patients (44, 68.8%), with an average age of 46.6 ± 13.9 years and an average body mass index of 28.4 ± 7.9. Fracture pattern distribution did not differ significantly between the early and delayed fixation cohorts ( P = 0.754 for Schatzker classification and P = 0.569 for OTA/AO classification). The relative risk of infection for the DF cohort was 2.17 (95% confidence interval, 1.04-4.54) compared with the EF cohort. Patients in the early fixation cohort were significantly more likely to have anatomic articular reduction compared with their delayed fixation counterparts (37.5% vs. 52.2%; P < 0.001). This study demonstrated higher rates of anatomic articular reduction in patients who underwent fixation of tibial plateau fractures before or at the time of fasciotomy closure for acute compartment syndrome compared with their counterparts who underwent definitive fixation for tibial plateau fracture after fasciotomy closure. The relative risk of overall infection for those who underwent fasciotomy closure after definitive fixation for tibial plateau fracture was 2.17 compared with the cohort that underwent closure before or concomitantly with definitive fixation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Predictive factors for infection after osteosynthesis of tibial plateau fractures: a retrospective study of 314 patients.

The reported incidence of infection related with tibial plateau fractures (IRTPF) ranges from 2 to 23%. This complication can result in catastrophic consequences such as deformity, post-traumatic osteoarthritis, chronic pain, loss of function, and substantial economic burdens on healthcare systems due to extended hospital stays and the resources required for treatment. Consequently, it is imperative to emphasize the identification of infection risk factors. A retrospective case-control study was designed, encompassing patients who underwent surgery for tibial plateau fractures between 2015 and 2020. Frequencies and measures of central tendency were compared between infected patients (cases) and non-infected patients (controls) using rank-based statistical tests. Subsequently, two logistic regression models were employed to control for potential confounding variables. A total of 314 patients were included, predominantly male (71.15%). Average age of 44.41years. IRTPF were observed in 7.64% of the patients. In the univariate inferential statistical analysis, high-energy fractures (OR 6.35, p < 0.001), fractures with compartment syndrome (OR 7.10, p < 0.001), two-stage management with temporary external fixation (OR 8.18, p < 0.001), the use of 2 or more approaches in definitive surgery (OR 2.93, p = 0.011), and the use of two or more plates (OR 9.17, p < 0.001) were identified as risk factors for infection. On average, the duration of surgery in infected patients was 201.2min, compared to 148.4min in non-infected patients (p < 0.001). When performing two logistic regression models, the following independent risk factors were identified: high-energy fractures (OR 5.04, p = 0.012), the presence of compartment syndrome (OR 4.53, p = 0.007), and the use of two or more plates in definitive surgery (OR 5.04, p = 0.023). High-energy tibial plateau fractures (Schatzker IV, V, and VI), the presence of concomitant compartment syndrome, and the use of 2 or more plates in definitive surgery are associated with a higher risk of infection related to fracture following open reduction and osteosynthesis treatment. Case-Control Study.

Staged treatment of bicondylar tibial plateau fractures: influence of frame configuration and quality of reduction on outcomes.

Despite evolving treatment, the surgical management of high-energy tibial plateau fractures (TPF) remains challenging, associating high rates of complications. In recent decades, staged management has emerged as an encouraging option. The main goal of our study was to evaluate the influence of bridging external fixation (EF) frame configuration and the resultant quality of reduction (QOR) on outcomes after staged-treatment of bicondylar TPF. A retrospective review was conducted of patients with bicondylar TPF treated at our level-I trauma center using a staged-treatment protocol from January 2010 to January 2020. Data on baseline characteristics, injuries, treatments, and clinical/radiological results were collected. The QOR was evaluated on CT images after EF and on plain films after ORIF. Sixty-eight patients were eligible for analysis. By our criteria, QOR was good in 57.4% and 70.6% after EF and ORIF, respectively. A squared EF configuration was associated with superior EF QOR (p = 0.032), while better EF QOR was linked to improved ORIF QOR (p = 0.016). No relationship between ORIF delay and ORIF QOR was identified. Postoperative complications were documented in 19 patients. Average ROM at one-year follow-up was 114.9 ± 12.6°, and non-influenced by anterior femoral pin placement. Staged management of bicondylar TPF resulted in a reasonable rate of complications. A direct relationship between QORs obtained with EF and after ORIF was found. Squared frames were associated with faster and better reductions, regardless of the surgeon's background. Considering our results, we advocate for the wider use of squared EF configurations in these patients.

A study of complications and their associated factors in the management of high-energy tibial plateau fractures treated by open reduction and internal fixation

Background: Tibial plateau fractures are one of the leading causes of joint dysfunction in major weight-bearing joints. Maintained articular surface, uniform plateau level, and a near-normal range of knee joint motion can all be preserved following the appropriate surgical guidelines. Aims and Objectives: The objectives of the study are as follows: (1) To study the complications and their associated factors in the management of high-energy tibial plateau fractures treated by open reduction and internal fixation. (2) To assess radiological parameters pre-operative and post-operative and their relation to fracture pattern. (3) To assess factors, such as fracture patterns, those influence the loss of reduction. Materials and Methods: Statistical analysis was done by expressing the data in frequency, percentage, mean, and standard deviation. Repeated measures ANOVA test or Friedman test or Wilcoxon signed-rank test will be used to compare radiological parameters from pre-operative to opposite side of the limb, and immediate post-operative to 6 weeks and 3 months. Results: Thirty-one cases of proximal tibial plateau fractures were studied between January 2021 and September 2022. The joint width has reduced in the immediate post-operative and has almost remained the same at 45 days and 3 months. The articular step off was noted to have a reduction of 0.3 mm in particular depression which is not significant. In the comparison of tibial offset preoperatively to the immediate post-operative and the 45-day and 12-week follow-up values, there was decrease in the values from the pre-operative to immediate post-operative radiographs and the reduction in the values noted in the further follow-ups is not significant. Conclusion: There was statistical significant difference noted between the pre-operative and immediate post-operative radiological parameters such as joint space width, tibial offset, and medial tibial plateau angle. Further radiological assessment done at 6-week and 3-month post-operative, there was no statistically significant loss of reduction.

An Acute Fixation Protocol for High-Energy Tibial Plateau Fractures Decreases Time to Fixation and Lowers Operative Costs Without Affecting Wound Complications and Reoperations.

To investigate whether an acute fixation protocol for high-energy tibial plateau fractures increases the rate of wound complications. Retrospective comparative study. Urban level 1 trauma centerPatients/Participants: 134 patients with high-energy tibial plateau fractures (OTA/AO 41B/C [Schatzker VI/V/VI]) treated with open reduction and internal fixation (ORIF). Utilization of an acute ORIF (<48 hours) versus delayed ORIF (>7 days) protocol. Primary outcomes: wound complications (wound dehiscence/necrosis, superficial/deep infections) and reoperations. Secondary outcomes: total operative costs and hospital length of stay (LOS). 83.9% (26/31) of patients received definitive fixation within 48 hours under the acute ORIF protocol versus 18.4% (19/103) of patients treated under the standard delayed protocol with no observed differences in the rate of wound complications (proportional difference (PD) -4.6%, confidence interval (CI) -17.2 to 11.3%; p=0.78) or reoperations (PD -2.0%, CI -13.0 to 12.5%; p=1.00). The acute ORIF protocol lowered operative costs (median difference (MD) $-2.563.00, CI -3021.00 to -1,661.00; p<0.001) and hospital LOS (MD -4.0 days, CI -6.0 to 1.0; p=0.001). On multivariate analysis, wound complications were associated with increasing age (odds ratio (OR) 1.05, CI 1.01 to 1.10; p=0.01) and tobacco use (OR 3.75, CI 1.19 to 11.82; p=0.02). An acute ORIF protocol for high-energy tibial plateau fractures decreased time to fixation and lowered operative costs without increasing the risk of wound complications or reoperations.

Maintenance of an Intraoperative External Fixator Is Associated With Decreased Postoperative Stiffness After Definitive Management of High-Energy Tibial Plateau Fractures.

Introduction Postoperative stiffness is a common complication after high-energy tibial plateau fractures. Investigation into reported surgical techniques for the prevention of postoperative stiffness is limited. The purpose of this study was to compare the rates of postoperative stiffness after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not. Methods Two hundred forty-four patients met the inclusion criteria between the two academic Level I trauma centers, representing the retrospective observational cohort. Patients were separated based on prepping of the external fixator into the surgical field during second-stage definitive open reduction and internal fixation. One hundred sixty-two patients were in the prepped group and 82 were in the non-prepped group. Post-operative stiffness was determined by the need to return to the operating room for subsequent procedures. Results At the final follow-up (mean = 14.6 months), patients in the non-prepped group had an increased rate of stiffness post-operatively (18.3% non-prepped versus 6.8% prepped; p = 0.006). No other investigated variables were associated with increased post-operative stiffness, including the number of days spent in the fixator and operative time. The relative risk for post-operative stiffness associated with complete fixator removal was 2.54 (95% CI 1.26-4.41; p = 0.008 on binary logistic regression; absolute risk reduction 11.5%). Conclusion At the final follow-up, maintenance of an intraoperative external fixator as a reduction aid was associated with a clinically significant decrease in post-operative stiffness after definitive management of high-energy tibial plateau fractures, when compared with complete removal prior to prepping.

Radiographic parameters associated with fracture-related infection in high energy bicondylar tibial plateau fractures managed with two-stage treatment: Identifying the bad actors

High energy tibial plateau fractures are fraught with complications, particularly fracture-related infection (FRI). Previous studies have evaluated patient demographics, fracture classification, and injury characteristics as risk factors for FRI in patients with these injuries. This study evaluated the relationship between radiographic parameters (fracture length relative to femoral condyle width (FLF ratio), initial femoral displacement (FD ratio), and tibial widening (TW ratio)) and fracture-related infection following internal fixation in high energy bicondylar tibial plateau fractures. 225 patients treated for bicondylar tibial plateau fractures at two level I trauma centers were retrospectively reviewed. Patient characteristics, fracture classification, and radiographic measurements were analyzed to determine association with FRI. The rate of FRI was 13.8%. Increased fracture length, FLF ratio, FD ratio, TW ratio, and fibula fracture were each associated with FRI on regression analysis, independent of clinical variables. Cutoff values were identified for each parameter and patients were risk stratified based on these radiographic parameters. High-risk patients had a 2.68- and 12.36-times risk of FRI compared to medium and low-risk patients, respectively. This study is the first to examine the relationship between radiographic parameters and FRI in high energy bicondylar tibial plateau fractures. Fracture length, FLF ratio, FD ratio, TW ratio, and fibula fracture were identified as radiographic parameters associated with FRI. More importantly, risk stratifying patients based on these parameters accurately identified patients at increased risk of FRI. Not all bicondylar tibial plateau fractures are created equal and radiographic parameters can be utilized to help identify the bad actors.

Protocolo para el manejo en urgencias de pacientes con fractura de meseta tibial.

High-energy tibial plateau fractures are associated with extensive soft tissue involvement and extensive joint destruction. Adequate management in the Emergency Room is essential to limit local damage and prepare definitive treatment. An emergency management protocol for patients with tibial plateau fractures is presented. It describes actions upon first contact with the patient, including imaging to help classify the injury, and decision-making regarding initial surgical fixation to maintain adequate bone stability and optimal soft tissue management.

Translated article] The use of arthroscopy does not increase the incidence of complications in the management of Schatzker IV–VI tibial plateau fractures

Background and objectiveThe use of arthroscopy for tibial plateau fractures type I, II and III according to Schatzker classification has increased, yet its employment for tibial plateau fractures Schatzker IV, V and VI is controversial due to the potential risk of compartment syndrome, deep vein thrombosis and infection. We aimed to compare the rate of operative and postoperative complications among patients with these types of tibial plateau fractures treated with and without arthroscopy at the time of definitive reduction and osteosynthesis. MethodsRetrospective cohort study. Patients with diagnosis of tibial plateau fracture Schatzker IV, V or VI who underwent reduction and definitive osteosynthesis with or without the use of arthroscopy were included. The development of compartment syndrome, deep vein thrombosis, and fracture-related infection was evaluated up to 12 months after the definitive surgery. ResultsTwo hundred eighty-eight patients were included: 86 with arthroscopic assistance and 202 without it. The overall complication rate in the group with and without arthroscopic assistance was 18.60% and 26.73%, respectively (p=.141). No statistical association was found between the use of arthroscopic assistance and the development of the analysed complications. Discussion and conclusionThe use of arthroscopy to support reduction or addressing concomitant intra-articular injuries did not increase the risk of complications in patients with high-energy tibial plateau fractures at 12 months of follow up.

El uso de artroscopia no aumenta la incidencia de complicaciones en el manejo de fracturas de mesetas tibiales Schatzker IV-VI

Background and objectiveThe use of arthroscopy for tibial plateau fractures type I, II and III according to Schatzker classification has increased, yet its employment for tibial plateau fractures Schatzker IV, V and VI is controversial due to the potential risk of compartment syndrome, deep vein thrombosis and infection. We aimed to compare the rate of operative and postoperative complications among patients with these types of tibial plateau fractures treated with and without arthroscopy at the time of definitive reduction and osteosynthesis. MethodsRetrospective cohort study. Patients with diagnosis of tibial plateau fracture Schatzker IV, V or VI who underwent reduction and definitive osteosynthesis with or without the use of arthroscopy were included. The development of compartment syndrome, deep vein thrombosis, and fracture-related infection was evaluated up to 12 months after the definitive surgery. ResultsTwo hundred eighty-eight patients were included: 86 with arthroscopic assistance and 202 without it. The overall complication rate in the group with and without arthroscopic assistance was 18.60% and 26.73%, respectively (P=.141). No statistical association was found between the use of arthroscopic assistance and the development of the analyzed complications. Discussion and conclusionThe use of arthroscopy to support reduction or addressing concomitant intra-articular injuries did not increase the risk of complications in patients with high-energy tibial plateau fractures at 12 months of follow up.

Treatment of High Energy Tibial Plateau Fractures with Hybrid External Fixation

Objective: The current study aimed to assess the treatment results of high energy tibial plateau fractures with hybrid external fixation. Methodology: It included 20 adult patients (17 males and 13 females). At emergency rooms, patients were clinically and radiologically evaluated according to standard protocols, then the assessment was completed and treatment was started in the inpatient department. Preoperative preparation was completed according to standard protocols. Then, the surgical fixation was performed and the patient scheduled for postoperative evaluation. Radiological evaluation had been achieved by anteroposterior and lateral X-ray of the knee and leg. Computed tomography and Doppler ultrasound were requested for specific patients when indicated. Routine laboratory investigations were carried out. All operations carried out under spinal anesthesia. The 1st follow up visit was at the 2nd week postoperative, and follow up was done every 2 weeks. In each visit, patient was assessed clinically and by radiological investigations. Results: Five patients (25 %) had excellent, 8 patients (40%) had good, 2 patients (10 %) had fair, 5 patients (25%) had poor final result. In addition, 13 patients (65%) had no varus or valgus angulation, 18 patients (90 %) had 0-5mm limb shortening, 14 patients (70 %) had normal knee range of motion, 12 patients (60 %) had no pain and 14 patients (70 %) had normal gait. Two patients had non-union treated by removal of Ilizarov, proximal tibial locked plate, autologous iliac bone graft. 6 patients had multiple degrees of stiffness treated by physiotherapy and had fair, good outcomes, 3 patient had Pin track infection treated by surgical debridement with good outcome, 1 patient had deep vein thrombosis DVT treated by anticoagulant medication. Conclusion: Hybrid external fixation is a safe and effective treatment modality for tibial plateau fractures.

Functional Outcome of Surgical Management of Tibial Plateau Fractures: A Prospective Observational Study

Background: Because of intra-articular nature, tibial plateau fractures are significant and difficult to manage. Low and high-energy tibial plateau fractures usually result from axial loading in combination with valgus stress forces, present a variety of soft tissue and bony injuries that can produce permanent disabilities. Although there are various modalities for fixation of these fractures with satisfactory results, but there is no general consensus as to which modality is the best in terms of functional outcome and proving the superiority of one over the other. Aim of the Study: The study aimed to evaluate the functional outcome of surgical management of tibial plateau fractures. Methods: It was a prospective observational study conducted in the Trauma Center, Bangabandhu Sheikh Mujib Medical College (BSMMC) &amp; Hospital, Faridpur, Bangladesh during the period from January 2021 to December 2021. In total 85 more than 20 years old patients of both sexes with tibial plateau fractures attended to the mentioned hospital during the first six months of the study were selected as the study population. Obeying the inclusion criteria of this study, only simple fractures of tibial plateau presenting in patients requiring open or closed reduction as well as internal fixation to restore the articular anatomy were finalized for this study. Result: In this study, according to the Schatzker classification and outcomes as per the recommendation of Rasmussen et al., 89% (n=76) patients got acceptable outcomes whereas the rest 11% (n=9) did not get satisfactory results. For majority (55%) of the patients, the union time was found &lt;12 weeks whereas in 2% cases (n=2) incidence of non-union was observed. Besides these, in general grading of patient’s outcome as per patient’s satisfaction, 56% patients got excellent results. Conclusion: In this study we found satisfactory outcomes in majority of the patients but in case of more than 10% cases outcomes were not acceptable. .............

Are Infection Rates Increased After Sterilization of the External Fixator During Staged Internal Fixation of High-Energy Tibial Plateau Fractures?

To compare infection rates after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not. Retrospective cohort study. Two academic Level 1 trauma centers. Two hundred forty-four patients met inclusion and exclusion criteria between the 2 institutions. Prepping of the external fixator into the surgical field during second-stage definitive open reduction and internal fixation. 162 patients were in the prepped group, and 82 patients were in the nonprepped group. The primary outcome was the rate of deep infection after definitive fixation. Secondary outcome was operative time. There were no significant differences in infection rates between prepped (11.7%) and nonprepped (18.3%) groups ( P = 0.162). Patients in the prepped groups had significantly decreased operative time (168.2 minutes vs. 221.9 minutes, P &lt; 0.001) even after controlling for confounders in regression analysis. There is no increased risk of infection associated with prepping and maintenance of the external fixator during definitive internal fixation for high-energy tibial plateau fractures. These data suggest that this practice may lead to shorter operative times as well. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Do number and location of plates impact infection rates after definitive fixation of high energy tibial plateau fractures?

Surgical trauma may confer additional infectious risk after operative fixation for high energy tibial plateau fractures. This study aims to determine the impact of plate number and location on infection rates after these injuries. This retrospective cohort study completed at two level one trauma centers included patients who underwent staged fixation for a tibial plateau fracture between 2015 and 2019. Plate number and location (lateral, medial, posteromedial, and anterior quadrants) used in the definitive fixation construct were collected from post-operative radiographs. Deep infection rate was primary the outcome. A total of 244 patients met inclusion criteria. The overall infection rate was 13.9% (34/244). Infection rates increased with each additional quadrant utilized (8.0% one quadrant, 13.0% two quadrants, 27.3% three quadrants, 100% four quadrants; p < 0.001), independent of plate number, fracture severity, operative time, number of incisions, external fixator pin and plate construct overlap, and days in the external fixator on multivariate analysis. Infection risk increases with each quadrant utilized in the fixation of high energy tibial plateau fractures. Providers should attempt to limit the dissection of soft tissue for hardware placement in the fixation of these injuries to limit infection risk. Level III, retrospective therapeutic study.

Comparative analysis of tibial plateau fracture osteosynthesis: A finite element study

This study presents a comparative structural finite element analysis between two different fixation methods for high-energy tibial plateau fractures: limited contact dynamic compression plate (LC-DCP) and locking compression plate (LCP). Several computational methods were employed to obtain an accurate finite element bone model with non-homogeneous properties. The goal is to evaluate the mechanical behavior of the fractured bone under each type of treatment within the scope of a single case study. Based on Computed Tomography (CT) images from the human lower limbs, the bones and implants were modeled using Computer-Aided-Design (CAD) with Autodesk Fusion 360©. Afterwards, finite element analysis was carried out in both assemblies. Altair HyperWorks© was used for pre- and post-processing the analysis and Abaqus CAE© was chosen as solver. The finite element model was built considering the boundary conditions foreseen in the specific bibliography and the assembly was submitted to a vertical compressive load based on the human Body Weight (BW). The results of both simulations were compared regarding the independent motion of the bone fragments over the fracture site. Smaller relative displacement between the bone fragments leads to shorter recovery time since this condition provides more stability and low tissue strain, which are required to generate bone. The osteosynthesis with LCP achieved the best results since it presented reduced independent motion in the fracture site, as foreseen in literature.

External Fixation Characteristics Drive Cost of Care for High-Energy Tibial Plateau Fractures.

To determine the total cost for a 30-day episode of care for high-energy tibial plateau fractures and the aspects of care associated with total cost. Time-driven activity-based costing analysis. One Level 1 adult trauma center. One hundred twenty-one patients with isolated, bicondylar tibial plateau fractures undergoing staged treatment were reviewed. Total cost. A total of 85 patients were included and most sustained Schatzker VI fractures (n = 66, 77%). All patients were treated with biplanar external fixation before definitive fixation. A total of 26 patients (31%) were discharged to skilled nursing facilities, and 37 patients (43%) were not discharged between procedures. Total cost for a 30-day episode of care was $22,113 ± 4056. External fixation components ($5952, 26.9%), length of hospital stay ($5606, 25.4%), discharge to skilled nursing facility (SNF) ($3061, 13.8%), and definitive fixation implants ($2968, 13.4%) contributed to the total cost. The following were associated with total cost: patient discharged to SNFs (P < 0.001), patient remaining inpatient after external fixation (P < 0.001), days of admission for open reduction internal fixation (ORIF) (P = 0.005), days spent with external fixation (P < 0.001), days in a SNF after ORIF (P < 0.001), and external fixation component cost (P < 0.001). External fixation component selection is the largest contributor to cost of a 30-day episode of care for high-energy bicondylar tibial plateau fractures. Reduction in cost variability may be possible through thoughtful use of external fixation components and care pathways. Economic analyses Level IV. See Instructions for Authors for a complete description of levels of evidence.

Posteromedial tibial plateau fractures – Functional outcome of posteromedial buttress plating with precontoured locking plate using modified lobenhoffer approach

Posterior tibial plateau fractures have a complex intra-articular fracture pattern, representing approximately 1.2% of all fractures. The occurrence of the posteromedial shear fragment is relatively common in high-energy tibial plateau fractures. Aims and Objectives: To study the role of posteromedial plating in the management of complex tibial plateau fractures with a posteromedial fragment. Materials and Methods: Only patients with posteromedial fracture patterns alone are taken into account. Twenty cases above 20 years of age, from the patient, admitted to Government Medical College, Thrissur, with posteromedial fragment in tibial plateau fractures that were operated were undertaken for the study. The patients were followed up for 2 years. Results: Of the 20 patients with posteromedial tibial plateau fractures from X-ray and computed tomography scan of the knee joint, all patients were treated with precontoured posteromedial buttress plating using single anatomical locking plate. We analyzed patients with Rasmussen scoring postoperatively. In our analysis, among 20 patients, the functional score was excellent in 14, good in 5, fair in 1, and poor in none. There was one patient with compartment syndrome who had developed a mild surgical site infection that later resolved. No excessive collapse is seen postoperatively since locked plate is used. Four patients had transient paraesthesia of the saphenous nerve; both resolved completely.

Functional outcome of hybrid external fixator in proximal tibial fractures Schatzker type V and VI with Gustillo grade-II

&lt;h2&gt;Background: Management of high energy tibial plateau fractures along with extensive soft tissue damage is still challenging to many orthopaedic surgeons. This study evaluates the purpose of hybrid external fixator intreating high energy tibial plateau fractures with minimal invasion and accurate reduction.&lt;/h2&gt;&lt;h2&gt;Methods: Twenty patients with high energy Schatzker type V and VI tibial plateau fractures with severe soft tissue injury were enrolled into the study in RNT medical college, Udaipur.&lt;/h2&gt;&lt;h2&gt;Results: The results- bony union, range of movements and associated complications were assessed. All fractures united in an average time period of 20 weeks. Ten patients developed knee stiffness, five patients developed delayed union andthreenon-union.15 patients required split skin graft. Final outcome showed excellent score in 53 patients.&lt;/h2&gt;&lt;h2&gt;Conclusions: Hybrid external fixation is a safe option for managing complex high energy tibial plateau fractures by simultaneously providing adequate fracture stabilization and necessary protection to soft tissue healing to achieve bony union.&lt;/h2&gt;

Treatment of Tibial Plateau Fractures By Circular External Fixator

Background: Tibial plateau fracture is challenging for orthopaedic surgeons because of the severity of trauma and associated soft tissue injuries. The treatment goals are to anatomically reconstruct the proximal tibial articular surface, restore limb axial alignment, and fix metadiaphyseal comminution to allow early knee mobilization and weight bearing.Aim: To evaluate the functional, clinical and radiological outcomes of treatment of high energy tibial plateau fractures by circular external fixator ± percutaneous screw fixation.Patients and Methods: Between June 2018 and July 2019, 20 tibial plateau fractures in 20 patients were treated with Ilizarov external fixator in Benha University hospital. The mean age was 39 years (range 22–55 years), and the mean follow-up period was 11±2 months (range 8–12 months). Closed reduction was performed by closed means in 70% of cases or through minimal incisions in 30% of cases. Clinical and functional evaluation of patients in the tibial plateau group was performed.Results: All patients started weight bearing the day after the surgery. Functionally, 70% had an excellent result, 20% had a good result. Radiologically 75% of had excellent results. Pin tract infection was controlled in all patients without need to implant removal.Conclusion: The degree of soft tissue injury associated with tibial plateau fracture is an important determinant for both the choice of the treatment modality and the prediction of treatment outcome. The use of Ilizarov external fixator is safe and effective option for the treatment of difficult Schatzker IV, V and VI tibial plateau fractures.